Daniel Abram Driscoll, MD/PHD
Individual provider Active NPI Pediatrics Physician · Bisbee, AZ
NPI 1689744591 · NPPES record last updated Jul 24, 2024
Key facts
- NPI
- 1689744591
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 34024 (CO)
- Practice address
- 108 Arizona St
Bisbee, AZ 85603-1804 - Phone
- (520) 432-3309
- Fax
- (520) 364-4261
- NPI assigned
- Nov 8, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Owned or controlled facilities with NPI records 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Bisbee Family Health Center |
Federally qualified health center | Corporate Officer W-2 Managing Employee |
Jan 1, 2023 Jan 1, 2023 |
| Behavioral Health Center - Sierra Vista |
Federally qualified health center | Corporate Officer W-2 Managing Employee |
Jan 1, 2023 Jan 1, 2023 |
| Douglas Acute Care |
Federally qualified health center | Corporate Officer Corporate Director W-2 Managing Employee |
Jan 1, 2023 Jan 1, 2023 Jan 1, 2023 |
| Bisbee Pediatrics and Community Health Services |
Federally qualified health center | Corporate Officer Corporate Director W-2 Managing Employee |
Jan 1, 2023 Jan 1, 2023 Jan 1, 2023 |
| Sierra Vista Behavioral Health Center |
Federally qualified health center | Corporate Officer Corporate Director W-2 Managing Employee |
Jan 1, 2023 Jan 1, 2023 Jan 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180730000258 | AZ | Practitioner - Pediatric Medicine | 2365480019 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine, Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chiricahua Community Health Centers, Inc | Current |
Accepting new patients | |
| Chiricahua Community Health Centers, Inc | Current | Accepting new patients | |
| Chiricahua Community Health Centers, Inc. | Current |
Accepting new patients | |
| Future Hope Clinic LLC | Pediatrics | Past | Accepting new patients |
Locations
335 S Ocotillo St
Benson, AZ 85602
Phone (520) 326-4811
108 Arizona St
Bisbee, AZ 85603
Phone (520) 432-3309
815 E 15th St
Douglas, AZ 85607
Phone (520) 364-5437
1111 N F Ave
Douglas, AZ 85607
Phone (520) 364-6860
1151 E 16th St
Douglas, AZ 85607
Phone (520) 364-5437
1205 N F Ave
Douglas, AZ 85607
Phone (520) 364-6852
1100 N F Ave
Douglas, AZ 85607
Phone (520) 364-3285
10566 N Highway 191
Elfrida, AZ 85610
Phone (520) 642-2222
155 Calle Portal
Ste 300
Sierra Vista, AZ 85635
Phone (520) 458-6331
155 Calle Portal
Ste 700
Sierra Vista, AZ 85635
Phone (520) 459-0203
251 W Rex Allen Dr
Willcox, AZ 85643
Interoperability endpoints
- daniel.driscol.p1@direct.cchci.nextgenshare.com
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 34024 | CO | Yes |
Addresses
Primary practice location
108 Arizona St
Bisbee, AZ 85603-1804
Mailing address
1205 N F Ave
Douglas, AZ 85607-1920
Phone (520) 364-1429
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01340249 | Medicaid | CO | |
| 396675 | Medicaid | AZ |
Other providers in Bisbee, AZ
- W Patrick Coghlan
- Community Bridges, Inc.
- Community Intervention Associates, Inc.
- Cheryl Dehaven
- Arleene Evelynne Djordjevic
- Jennifer E. Druckman
- Jessica Lee Fontes
- Frances Jones Dba Oxicheck NW
- Mirna Lorena Franco
- Denice Maylene Gaddie
All providers in Bisbee, AZ · Pediatrics Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.